DRM, Others File Suit to Improve Outcomes from Medicaid Appeals.

Medicaid recipients have long had rights to “fair hearings” to challenge actions affecting their benefits. According to a new lawsuit, however, Medicaid recipients in Michigan cannot get relief from those hearings, even when they win. Attorneys for Disability Rights Michigan (DRM), the National Center for Law and Economic Justice (NCLEJ) and Legal Services of South Central Michigan (LSSCM), filed suit against the State of Michigan to improve the process and outcomes of community mental health administrative hearings. The suit says that the administrative law judges (ALJs) presiding over fair hearings lack the power to order the agency to grant the benefits it had wrongfully denied. All they can do is send the case back to the agency to “reassess” the recipient. And when the agency comes back with the same decision on reassessment, all the recipient can do is ask for another fair hearing, where the same thing will happen again.

“The Medicaid Fair Hearing System is supposed to give recipients the right to challenge actions that negatively affect their benefits,” said Kyle Williams, Litigation Director for DRM. “If administrative law judges are only allowed to order reassessments, they can never win those challenges, because the reassessment decision is ultimately in the hands of the agency that took the negative action in the first place.”